Euthanasia, also called mercy killing, act or practice of painlessly putting

to death persons suffering from painful and incurable disease or incapacitating physical disorder
or allowing them to die by withholding treatment or withdrawing artificial life-support measures.
Because there is no specific provision for it in most legal systems, it is usually regarded as
either suicide (if performed by the patient himself) or murder (if performed by another).
Physicians may, however, lawfully decide not to prolong life in cases of extreme suffering, and
they may administer drugs to relieve pain even if this shortens the patient’s life. In the late 20th
century, several European countries had special provisions in their criminal codes
for lenient sentencing and the consideration of extenuating circumstances in prosecutions for
euthanasia.

The legal position

Euthanasia is illegal in most countries, although doctors do sometimes carry out euthanasia
even where it is illegal.

Euthanasia is illegal in Britain. To kill another person deliberately is murder or

manslaughter, even if the other person asks you to kill them. Anyone doing so could potentially
face 14 years in prison.

Under the 1961 Suicide Act, it is also a criminal offence in Britain, punishable by 14 years'
imprisonment, to assist, aid or counsel somebody in relation to taking their own life.

Nevertheless, the authorities may decide not to prosecute in cases of euthanasia after taking
into account the circumstances of the death.

In September 2009 the Director of Public Prosecutions was forced by an appeal to the
House of Lords to make public the criteria that influence whether a person is prosecuted. The
factors put a large emphasis on the suspect knowing the person who died and on the death being a
one-off occurrence in order to avoid a prosecution.

People have debated over the ethics and legality of euthanasia and PAS for centuries.
Today, laws about euthanasia and PAS are different across states and countries.
In the United States, PAS is legal in:

 Washington

 Oregon

 California

 Colorado

 Montana

 Vermont

 Washington, D.C.

 Hawaii (beginning in 2019)

Each of these states and Washington, D.C. have different legal requirements. Not every
case of PAS is legal. In addition, many states currently have PAS measures on legislative ballots,
so this list may grow.

Outside the United States, PAS is legal in:

 Switzerland

 Germany

 Japan

Euthanasia, including PAS, is legal in several countries, including:

 the Netherlands

 Belgium

 Luxembourg

 Colombia

 Canada
 When to Perform Euthanasia

Some factors to consider in deciding whether to perform euthanasia are weight loss;
emaciation; failure to gain weight (in a growing animal); severe pain that cannot be controlled;
inordinate tumor growth or ascites; prolonged self-trauma; generalized alopecia caused by disease;
prolonged diarrhea for which treatment is precluded in the protocol; coughing, wheezing, or severe
nasal discharge; shallow and labored breathing; prolonged lethargy associated with rough hair
coat, hunched posture, abdominal distention, or impaired movement; severe anemia or leukemia;
icterus; CNS signs, such as convulsions, paralysis, paresis, tremors, and progressive head tilt;
uncontrolled hemorrhage; urinary dysfunction (polyuria or anuria); lesions that interfere with
eating or drinking; infectious disease (in terminal phases); hypothermia; and impairment of
function, disablement, and other behavioral and physiologic signs of distress.

Information on signs of pain, distress, morbidity, and moribund condition in previous

chapters of this volume should be used to determine when euthanasia is appropriate and justified.
Another factor in the decision is the differentiation between a condition from which animals might
recover and a moribund condition that is likely to progress to death. Principal investigators, study
directors, attending veterinarians, and institutional animal care and use committees (IACUCs)
should collaborate in determining general policies regarding end points of studies and when to
perform euthanasia. In specific instances when euthanasia should be considered for humane
reasons, attending veterinarians should consult with principal investigators and study directors in
making a final decision. The IACUC at the University of Texas M. D. Anderson Cancer Center
has considered this issue for rats and mice used in the center's programs (Tomasovic et al., 1988).
Such guidelines, applied case by case, provide a rationale for determining whether potentially
lethal experiments are justified in accordance with institutional policy and the merits of the
research.

Human Cloning

Although the possibility of cloning humans had been the subject of speculation for much
of the 20th century, scientists and policy makers began to take the prospect seriously in the mid-
1960s. J. B. S. Haldane was the first to introduce the idea of human cloning, for which he used the
terms "clone" and "cloning", which had been used in agriculture since the early 20th century. In
his speech on "Biological Possibilities for the Human Species of the Next Ten Thousand Years"
at the Ciba Foundation Symposium on Man and his Future in 1963, he said:
It is extremely hopeful that some human cell lines can be grown on a medium of precisely
known chemical composition. Perhaps the first step will be the production of a clone from a single
fertilized egg, as in Brave New World...
Assuming that cloning is possible, I expect that most clones would be made from people
aged at least fifty, except for athletes and dancers, who would be cloned younger. They would be
made from people who were held to have excelled in a socially acceptable accomplishment.
Work on cloning techniques has advanced our basic understanding of developmental
biology in humans. Observing human pluripotent stem cells grown in culture provides great insight
into human embryo development, which otherwise cannot be seen. Scientists are now able to better
define steps of early human development. Studying signal transduction along with genetic
manipulation within the early human embryo has the potential to provide answers to many
developmental diseases and defects. Many human-specific signaling pathways have been
discovered by studying human embryonic stem cells. Studying developmental pathways in humans
has given developmental biologists more evidence toward the hypothesis that developmental
pathways are conserved throughout species.

In bioethics, the ethics of cloning refers to a variety of ethical positions regarding the
practice and possibilities of cloning, especially human cloning. While many of these views
are religious in origin, the questions raised by cloning are faced by secular perspectives as well.
Human therapeutic and reproductive cloning are not commercially used; animals are currently
cloned in laboratories and in livestock production.

Organ Transplant

Organ transplantation is often the only treatment for end state organ failure, such as liver
and heart failure. Although end stage renal disease patients can be treated through other renal
replacement therapies, kidney transplantation is generally accepted as the best treatment both for
quality of life and cost effectiveness. Kidney transplantation is by far the most frequently carried
out transplantation globally.

The procurement of organs for transplantation involves the removal of organs from the
bodies of deceased persons. This removal must follow legal requirements, including the
definition of death and consent.
 Kidney donation by well selected living donors with good health coverage carries
negligible risks. This can only be ensured through rigorous selection procedures, careful
surgical nephrectomy and follow up of the donor to ensure the optimal management of
untoward consequences.

The Transplantation Society adopted a consensus statement on the care of the live
kidney donor, prepared by a forum involving over 100 experts from more than 40 countries
from around the world, in which representatives of WHO participated. This consensus
statement addresses the responsibility of communities for living donors. In particular it defines
the responsibilities of the transplant centre which is charged, inter alia, with facilitating the
long-term follow up of living kidney donors and, if need be, their treatment, with identifying
and tracking complications that may be important in defining risks for informed consent
disclosure (Consensus Statement of the Amsterdam Forum [pdf 100kb] on the care of the live
kidney donor).
The welfare of the live kidney donor is largely neglected in schemes where disadvantaged
individuals are exploited and encouraged to sell their kidneys.

Resolution WHA57.18. (2004) acknowledges the risk of exploitation of live kidney

donors and urges Member States to "protect the poorest and vulnerable groups from transplant
tourism and the sale of tissue and organs" and requests the Director-General to provide support
for Member States in this endeavour.

Test Tube Babies

A test-tube baby is the product of a successful human reproduction that results from
methods beyond sexual intercourse between a man and a woman and instead utilizes medical
intervention that manipulates both the egg and sperm cells for successful fertilization. The term
was originally used to refer to the babies born from the earliest applications of artificial
insemination and has now been expanded to refer to children born through the use of in
vitro fertilization, the practice of fertilizing an egg outside of a woman’s body. The use of the term
in both media and scientific publications in the twentieth century has been accompanied by
discussion as well as controversy regarding the ethics of reproduction technologies such
as artificial insemination and in vitro fertilization. The evolution of these terms over time
mirrors the perception of our ability to manipulate the human embryo, as seen by the general public
as well as the scientific community.
The term “test-tube baby,” prior to the development of in vitro fertilization technologies
in the twentieth century, was used to refer to babies born as a result of artificial
insemination. William Pancoast, a physician from Philadelphia, performed the first artificial
insemination that led to a successful birth in 1884, marking the birth of the first test-tube baby.
Despite the fact that this was the earliest instance of any sort of physician-assisted reproduction,
the grandeur of the event was not recognized by the public or media in any notable way.
As reproduction technology continued to develop and in vitro fertilization research
advanced in the mid twentieth century, the media began to pay more attention to the idea of test-
tube babies and the impact their existence would have on the world. Publications began to publish
articles in the early twentieth century that discussed the ethics behind the creation of children
through means other than human sexual intercourse. Such publications as The New York
Times, Scientific American, and Newsweek, among others, published articles discussing test-tube
babies and the technologies used to create them, focusing on what their existence meant for the
development of the public’s understanding of reproduction as well as the ethics involved with such
an advanced understanding. The articles refrained from being overtly outraged in response to the
experiments but recognized the controversy involved with these new scientific developments and
included this in their coverage.
By the middle of the twentieth century, in vitro fertilization had been thoroughly
researched and reported on, though no successful human reproduction had occurred from its
practice. However, the successful fertilization and reproduction of various species of animal
besides humans through in vitro fertilization was common practice by 1960. It was also around
this time that the discussion of a child born from in vitro fertilization began to show up in
numerous publications. Look magazine published an article in 1971 entitled “The Test Tube Baby
is Coming,” which reported on the work of Landrum Brewer Shettles, an American biologist who
would eventually attempt the first human in vitro fertilization in America, which was not
successful.
It was not until 25 July 1978 with the work of two British medical researchers, Patrick
Steptoe and Robert Edwards, that the revised definition of test-tube baby became a reality. With
their work, the first child born from a zygote fertilized outside of a human body was created. The
first baby born via in vitro fertilization was Louise Brown. It was also this breakthrough that really
caught the attention of the world, made clear in the media’s reaction to Louise Brown’s birth.
Newspapers reported the story as a significant scientific and medical breakthrough while tabloids
and other similar publications treated the birth more like the arrival of a new celebrity into the
world. The mixed media response to the birth of Louise Brown was also very foretelling of the
diverse public reactions that would follow. Shortly after the birth, discussion of both legal and
ethical implications regarding the existence of test-tube babies began in the international media as
well as in scientific journals. These debates continue to this day as the ongoing research of embryos
and reproduction leads to the development of new medical practices.
After the birth of Louise Brown, scientists in other countries around the world began
pursuing the birth of their first child from in vitro fertilization. This goal was also accompanied
by the development of numerous fertility clinics in various countries. The first fertility clinic in
the United States opened at the Eastern Virginia Medical School in Norfolk, Virginia on 1 March
1980. It was also here that Jordan Elizabeth Carr, the first child who was a product of in
vitro fertilization in America, was born on 28 December 1981. By this time, the practice of in
vitro fertilization was much more publicly accepted, as it was observed that children born under
such circumstances developed normally. This was not to say that there were no opponents to the
practice at this time, but rather that Carr’s birth was received with excitement from the general
public and the media captured this response when covering the event. More fertility clinics were
established all over the world and the number of successful test-tube baby births continued to grow
as in vitro fertilization became both a more refined and more accepted practice.
Through the work of various scientists, the idea of traditional fertilization and human
reproduction through sexual intercourse was no longer seen as the only means of fertilizing
an egg in order to create a human life. This concept was represented by the existence of test-tube
babies, the physical manifestation of a more advanced control over human reproduction. Through
the work of such scientists as Pancoast, Steptoe, and Edwards, the definition of test-tube baby has
changed over time but continues to refer to any child born from an embryo created by means of
medical intervention that directly manipulates the sperm and egg cells.
Surrogate Mother
Surrogate motherhood, practice in which a woman (the surrogate mother) bears a child
for a couple unable to produce children in the usual way, usually because the wife is infertile or
otherwise unable to undergo pregnancy. In so-called traditional surrogacy, the surrogate mother is
impregnated through artificial insemination with the sperm of the husband. In gestational
surrogacy, the wife’s ova and the husband’s sperm are subjected to in vitro fertilization, and the
resulting embryo is implanted in the surrogate mother. Normally, in either procedure, the surrogate
gives up all parental rights, but this has been subject to legal challenge.
The practice of surrogate motherhood, though not unknown in previous times, came to
international attention in the mid-1970s when a reduction in the number of children available
for adoption and the increasing specialization of techniques in human embryology made such
methods a viable alternative to lengthy and uncertain adoption procedures or childlessness.
Surrogate motherhood has raised a number of issues—such as the matter of payment for services
(which, taken to the extreme, has implications of making children a commodity) and the rights of
all of the individuals involved should any aspect of the procedure go awry.